Management of the Geriatric Trauma Patient at Risk of Death

Abstract

ELDERLY PERSONS represent worldwide the most rapidly growing sector of the population.¹ As life expectancy has been extended, and travel and recreational activity by individuals older than 65 years has increased, a consequence has been increasing numbers of geriatric patients with serious injury who require hospitalization for treatment. The number of geriatric patients triaged to trauma centers in the United States is projected to increase from 11% to 13% and worldwide from 4% to 7%.¹ Compared with younger trauma patients in vigorous health prior to injury, treatment of elderly trauma patients is more frequently complicated by multiple preexisting medical problems, infirmity, and impaired capacity to heal their acute injuries.² The death rate among hospitalized injured patients, adjusted for severity of injury, is higher for the elderly.³ Furthermore, elderly trauma patients who are discharged alive have a substantial risk of death in the first 2 months after hospital discharge.^4,5 Finally, the recovery of elderly patients is more commonly characterized by prolonged impaired function, and inability to return to independent living.⁶ Geriatric trauma patients may represent in the next decades the greatest challenge to those committed to optimal care of injured patients.